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The post-angiocardiography urogram in children: should it be abandoned?
J R Tuson1, K McHugh, L N Archer
1Department of Radiology, John Radcliffe Hospital, Oxford, UK.
Insights
Routine post-angiocardiography urograms in children with congenital heart disease are not valuable for detecting urinary tract abnormalities. Sonography is a more effective screening method for these patients.
Area of Science:
- Pediatric Cardiology
- Urology
- Diagnostic Imaging
Background:
- Congenital heart disease (CHD) in children can be associated with co-existent urinary tract abnormalities.
- The post-angiocardiography urogram has been used to screen for these abnormalities.
- The diagnostic yield and quality of these urograms require evaluation.
Purpose of the Study:
- To assess the value of post-angiocardiography urograms in identifying urinary tract abnormalities in pediatric patients with suspected congenital heart disease.
- To compare the effectiveness of urograms with alternative screening methods.
Main Methods:
- Retrospective audit of 184 post-angiocardiography urograms from 166 children (1990-1993).
- Review of image quality and detection of urinary tract lesions.
- Analysis of cases with prior urinary tract investigations.
Main Results:
- 13.6% of urograms provided no additional information due to prior investigations.
- 62 examinations (33.7%) had suboptimal image quality, leading to missed lesions.
- Urinary tract abnormalities were detected in 10.2% of patients, all identifiable by sonography.
Conclusions:
- Routine post-angiocardiography urograms are of limited value in screening for urinary tract abnormalities in children with congenital heart disease.
- Sonographic screening is a more effective and recommended approach for these patients.
- Abandoning routine urograms can improve resource allocation and patient care.
Abstract:
This study examines the value of the urogram radiograph taken after angiocardiography, in children with suspected congenital heart disease, to screen for co-existent urinary tract abnormalities. A retrospective audit of post-angiocardiography urograms over a three year period 1990 to 1993 is presented. 184 urograms obtained in 166 children were reviewed (86 males; mean age 18.1 months). Twenty-five urograms (13.6%) were obtained in cases where the urinary tract had previously been investigated. These urograms contributed no additional information. Image quality was suboptimal in 62 examinations (33.7%), due to gas, faeces or poor opacification, and two lesions were undetected on suboptimal radiographs. Urinary tract abnormalities were detected in 17 patients (10.2%). These lesions were also detectable at sonography. We suggest that routine post-angiocardiography urograms can be abandoned in favour of sonographic screening of the urinary tract in children with congenital heart disease.